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Medicare Contract Terms

McGuireWoods LLP

OIG Approves Multi-MSO Telehealth Arrangement That Meets AKS Safe Harbor

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On June 6, 2025, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a favorable advisory opinion concerning a proposed telehealth staffing and services arrangement involving a management...more

Hinshaw & Culbertson - Health Care

OIG Advisory Opinion 25-03: Navigating Anti-Kickback Rules and Safe Harbors in Telehealth Contractual Arrangements

On June 6, 2025, the Office of Inspector General (OIG) issued Advisory Opinion 25-03 (the “Opinion”), offering guidance for structuring telehealth collaborations in a manner that complies with the federal Anti-Kickback...more

ArentFox Schiff

Telehealth Staffing and Administrative Services Gain Favorable Advisory Opinion From OIG

ArentFox Schiff on

On June 6, the US Department of Health and Human Services’ Office of Inspector General (OIG) issued Advisory Opinion No. 25-03, providing important guidance for telehealth organizations and management services organizations...more

Robinson+Cole Health Law Diagnosis

OIG Green Lights MSO Model Arrangement for Telehealth Platforms in New Advisory Opinion

On June 11, 2025, the Department of Health and Human Services Office of Inspector General (OIG) published Advisory Opinion 25-03 (the Advisory Opinion), in which OIG approved of a proposed arrangement under which a management...more

Burr & Forman

Considerations Before Opting Out of Medicare

Burr & Forman on

In recent years, we have seen an emerging number of physicians and health care providers transitioning to concierge, direct-to-consumer practices. Many providers no longer want to deal with the hassles of billing insurance,...more

Stotler Hayes Group, LLC

CMS Cracks Down on Responsible Party Liability in LTC Admission Agreements

A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident...more

McDermott Will & Emery

This Week in 340B: January 7 – 13, 2025

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Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick...more

Tyson & Mendes LLP

Shining Light on Phantom Medical Bills–Lessons from Washington on Using Federal Hospital Price Transparency Rules to Fight Back

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How many of you reading this have had this experience: you get a settlement demand with hundreds of thousands of dollars in claimed hospital bills, but the actual amount owed by the claimant is redacted, or you are told by...more

Mintz - Health Care Viewpoints

The Uncertain Landscape of Medicare Agent/Broker Compensation Rules

In the Proposed Medicare Advantage and Part D Rules for 2025, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to how Medicare Advantage organizations (MAOs) are allowed to contract with and...more

Lippes Mathias LLP

Supreme Court Decides in Favor of Tribal Nations in Becerra v. San Carlos Apache Tribe

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The U.S. Supreme Court’s June 6 decision is a victory for Tribal Nations, affording them new opportunities to recover contract support costs pertaining to healthcare programs. In Becerra v. San Carlos Apache Tribe, the...more

Tucker Arensberg, P.C.

“Stark” Rules: Navigating Physician Leases and Subleases

Tucker Arensberg, P.C. on

Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable...more

Bricker Graydon LLP

OIG says Part D contracts cost Medicare as much as $75 million in lost drug manufacturer rebates in one year

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The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report on July 1, 2019, finding that Medicare Part D contracts between Medicare Prescription Drug Plan sponsors and drug...more

Poyner Spruill LLP

Shorts on Long Term Care - Fall 2018 - News for the North Carolina LTC Community

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Contract Review Tips for Long-Term Care Facilities - A long-term care facility can execute contracts with many different vendors including food product and service vendors, laundry and linen providers, IT companies, and...more

King & Spalding

Federal Judge Blocks CMS Rule Banning Arbitration In Nursing Home Disputes

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In September, CMS announced a final rule that bans pre-dispute binding arbitration agreements related to care received in long-term care facilities. Among other things, the rule preserves the right of patients and their...more

Cadwalader, Wickersham & Taft LLP

Federal Court Blocks CMS Ban on Pre-Dispute Nursing Home Arbitration Agreements Pending Legal Challenge: What the Ruling Means for...

Earlier this week, a federal court enjoined the federal Centers for Medicare and Medicaid Services (“CMS”) from enforcing a rule, promulgated on September 28, 2016, which barred pre-dispute arbitration agreements between...more

Ballard Spahr LLP

Federal Court Enjoins U.S. Agency’s Nursing Home Arbitration Agreement Ban

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The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, recently issued a final rule prohibiting nursing homes and other long-term care facilities from utilizing...more

Polsinelli

Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements - Part II

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Following CMS publishing the biggest overhaul to federal long-term care regulations in 25 years, affected facilities must take steps to ensure they are prepared for the pending changes. On Oct. 4, CMS published the...more

Holland & Knight LLP

Ten Things to Know About the CMS Long-Term Care Requirements Final Rule

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Deadlines are looming to come into compliance with sweeping changes to the Centers for Medicare & Medicaid Services (CMS) requirements for long-term care facilities (LTC) participating in Medicare and Medicaid. The CMS final...more

Polsinelli

Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements - Part I

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On Oct. 4, CMS published the biggest overhaul to federal long-term care regulations since 1991. The lengthy Final Rule reforms the requirements for long-term care facilities participating in Medicare and Medicaid. CMS...more

Cadwalader, Wickersham & Taft LLP

In Final Rule, CMS Acts to Bar Pre-Dispute Binding Arbitration Agreements With Nursing Home Residents Effective November 28, 2016

On September 28, 2016, the federal Centers for Medicare and Medicaid Services (“CMS”) issued its long-awaited final rule that, among other things, prohibits skilled nursing facilities (“SNFs”) and nursing facilities (“NFs”)...more

Ballard Spahr LLP

U.S. Agency Prohibits Nursing Home Arbitration Agreements

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The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, has issued a final rule that includes prohibiting nursing homes and other long-term care facilities from...more

Poyner Spruill LLP

Proposed Changes to Stark Rule Would Create New Hospital Exceptions and Lessen Burden of Self-Disclosures

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In a development that is limited in scope but still welcomed by hospitals, the proposed 2016 Physician Fee Schedule proposes a number of new exceptions to the physician self-referral or Stark law and other refinements that...more

Benesch

CMS Proposed Stark Law Revisions

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On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed revisions to the regulations implementing the physician self-referral law, or Stark Law. The Stark Law is a key regulatory...more

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